We need to be careful when comparing US and UK cancer care

It’s often said that where the US goes, we Brits will follow – and that’s certainly been true over the last week or so.

America is in the middle of a lengthy, bitter and at times bizarre debate, as President Obama tries to reform the US healthcare system. And as the debate has spilled over into the British media, focus has fixed on the relative pros and cons of our NHS.

As well as becoming the focus of newspaper columns and radio phone-ins, the debate has also set the internet alight, with commentators on both sides feeling compelled to ‘have their say’, as exemplified on social microblogging site Twitter.

Given that both the US and the UK economies are in recession, and both countries are facing spiralling healthcare costs as their populations age, it’s absolutely right that we have a proper and informed debate about how best to provide healthcare.

Cancer is a key area of concern for healthcare providers, not least because alongside demographic and economic problems, new-generation cancer treatments tend to be more expensive than their forerunners.

But over the last week, facts and figures about UK cancer care have been taken out of context on several occasions, and used to make questionable points about the NHS. So let’s set the record straight.

Breast cancer kills 25 percent of its American victims. In Great Britain …breast cancer extinguishes 46 percent of its targets.

We don’t know where this figure has come from. However, according to GLOBOCAN – an international comparison carried out in 2002 and probably the most recent comparable figures, the age-standardised figures are 24 deaths per 100,000 Britons, and 19 per 100,000 Americans – not nearly so dramatic a difference.

‘Fewer prostate cancer patients survive five years’

Another fact that has been widely quoted relates to prostate cancer. As the Guardian wrote:

A Lancet Oncology global study last year found that 91.9 per cent of Americans with the disease were still alive after five years compared to just 51.1 per cent in the UK.

On the face of it, these figures are indeed valid. They come from the CONCORD study, which we helped fund, and compared 5-year survival rates between many different countries.

But just comparing the US and the UK, and saying that the bigger number is ‘better’, misses a deeper truth.

As we’ve written before, the US uses the PSA blood test far more widely than we do in the UK – despite questions over how effective it is at spotting cancers that would actually kill, as opposed to those that cause no symptoms.

So although it’s undoubtedly ‘better’ at spotting prostate cancers, it’s also fair to say that some of these Americans will never die from their disease.

This ‘overdiagnosis’ inflates the survival statistics, at the expense of ‘overtreating’ men – which is expensive and can cause long-term side effects (which can need further treatment).

So you might just as well argue that the ‘91 per cent’ survival figure could be due to a system that overdiagnoses and overtreats prostate cancer, as opposed to saying our 51 per cent stat is due to poor healthcare in the UK. Bigger is not always better.

Finally, if you look at UK survival rates for early stage prostate cancer, a different picture emerges – men in the UK have a 98.6 per cent five-year survival rate. Clearly, whatever controversies surround the diagnosis of the disease, the NHS is doing a pretty good job of managing it when it’s detected early.

‘UK cancer patients find it harder to see an oncologist’

According to the Mirror, some US anti-reform adverts have been stating that 40 per cent of UK cancer patients “are never able to see an oncologist”. This figure originates from a report titled “Review of the pattern of cancer services in England and Wales” published by the Association of Cancer Physicians in 1994 – years before the NHS Cancer Plan and the Cancer Reform Strategy were put in place.

But things have improved hugely since 1994, thanks to the priority the UK government has placed on cancer care. Nowadays, the vast majority of cancer patients in the UK see a specialist within two weeks.

The dangers of international comparison

Another big difference between UK and US cancer statistics is that in the UK, every single cancer diagnosis and death is registered nationally. In the US there is not nearly such complete data. So even comparing data that’s been properly standardised doesn’t give the whole picture – as we mentioned when discussing the EUROCARE european data a while back.

But it’s only valid to compare international statistics, of any sort, if you compare like with like – and this is extremely difficult to do between different populations, especially when the nature of the data is fundamentally different.

We’re not saying the NHS is perfect. There’s a long way to go with many aspects of cancer care – early diagnosis, access to treatment, and end of life care, to name a few. But the picture that’s currently being painted in some quarters is very different from the reality.

As a final note, the statistics we’ve discussed in this post are, by their very nature, averages.

But when you’re diagnosed with cancer, doctors generally give you statistics that are more relevant to the type or stage of disease you yourself have – and these may be different from those above.

If you are a cancer patient, or know someone who is, and you have question about cancer, its treatment or care, have a look at our patient information website CancerHelp UK, or telephone our Information Nurses on freephone 0808 800 4040.

Henry

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As a yank who is also a health care provider I am interested in how the rest of the world manages health care. I am well aware of the holes in the American system and so, when I see statistics that make us look so good and Europe look third world, I know something is wrong. Thank you for an informative article

Women in Britton may actually have breast cancer at lower rates (or be less likely to be diagnosed with breast cancer) than American women. Still, of them 46 percent who are diagnosed with Breast cancer could still die. Therefore the 24 in 100,000 and 46 percent numbers can both be true.

Thank you to Henry, for explaining the truth behind the headlines. We need a cancer-only version of Ben Goldacre’s ‘Bad Science’.
Barriers to transatlantic cancer research need to be pulled down. Clinical resaerchers often say that the UK and US are too different for collaboration to work. But how much of that ‘difference’ is real?

“A mischievous observer could interpret this as meaning that there are 25 per cent more “deaths per 100,000″ in the UK.”

That is in fact what a lot of people in the media do. They will look at the increase in risk in relative terms (e.g. 25%) for scare headlines, but generally won’t give the absolute increase in risk, or at best bury that info near the bottom of the article.

I was diagnosed with breast cancer in 2002. I found a lump first week in January, saw the doctor 2 days later and by the first week in March I had had my tests, my diagnosis and my mastectomy and the cancer was gone. That’s two months all told. Afterwards I had to have chemotherapy to stop it from coming back and I have been offered reconstruction if I want it, which I don’t.I still get a mammogram and checkups very year, and I will till I get to the 10th anniversary, then I go back into the normal screening programme. All free on the NHS. Thank you for trying to put some sense into this discussion.

Indeed they could Michael – but the reason we quoted those stats wasn’t really to illustrate the relative merits of the NHS vs the US’s healthcare systems.

Yes there’s a significant difference (in the colloquial sense), but the two countries have very different ways of managing their breast screening programmes, and there are similar caveats and confounding factors here, just as there are in the case of the prostate cancer statistics we discussed.

Our point was not ‘x’ is better than ‘y’ – it was that comparing ‘x’ and ‘y’ is much more complex than saying one is bigger than the other!

Excellent, sensible post. Unfortunately actual facts have never been able to corrall the stampede of misinformation and panic.

Despite being someone who has plenty of misgivings about the NHS, I am watching a friend going through cancer treatment in its care and I am thoroughly impressed with the level and efficiency of treatment and the extensive support she’s being offered. So I readily believe that, at least when it comes to cancer, improvements have been and are being seen.

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